Treatment and Outcomes of Children and Adults With Rhabdomyosarcoma in Rwanda

BACKGROUND: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma affecting children and young adults, but few reports describe its presentation and outcomes in Africa. PROCEDURE: We conducted a retrospective chart review of patients of all ages with RMS presenting to the Butaro Cancer Center of Excellence in Rwanda between July 2012 and June 2022. RESULTS: Fifty-nine patients with histopathologically confirmed RMS were treated using Intergroup RMS Study Group protocols adapted to the local context. Median age was 9.1 years (interquartile range [IQR] 3.5-16.6); 54.2% were female. Median duration from symptom onset to presentation was 5 months (IQR 4-7). Most had embryonal histology (66.1%), followed by alveolar (20.3%), pleomorphic (6.8%), and anaplastic (1.7%). At presentation, 16 patients (27.1%) had stage I, 3 (5.1%) had stage II, 22 (37.3%) had stage III, and 14 (23.7%) had stage IV disease; 4 (6.8%) were unstaged. Of the 39 patients treated with curative intent, 25 (64.1%) received local control and 16 (41.0%) completed all planned therapy. Two-year event-free survival was 23.3% (95% CI 13.5%-34.8%, n = 55) overall and 61.4% (95% CI 33.3%-80.5%, n = 16) among those who completed treatment. CONCLUSIONS: Treatment of RMS in a rural district hospital is feasible. Although outcomes remain lower than in high-income countries, survival was markedly higher in patients who completed therapy. Future efforts should focus on earlier diagnosis and support for timely transitions between specialties with the goal of optimizing completion of planned care.